The Application of the Revised Condyle-C1 Interval Method to Diagnose Traumatic Atlanto-occipital Dissociation in Adults

Nader S. Dahdaleh*, Ryan Khanna, Arnold H. Menezes, Zachary A. Smith, Stephanus V. Viljoen, Tyler R. Koski, Patrick W. Hitchon, Brian J. Dlouhy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Study Design Retrospective study. Objective Traumatic atlanto-occipital dissociation (AOD) remains a diagnostic challenge, and delay in diagnosis is associated with catastrophic outcomes. Recently, a revised version of the condyl-C1 interval (CCI) utilizing parasagittal computed tomography (CT) reconstruction was used successfully with unilateral dislocation of 2.5 mm at the level of that joint diagnostic of AOD. We report the utility of this simple technique in the diagnosis of six patients with AOD. Methods Two blinded neurosurgeons assessed CTs of six patients with AOD and 30 patients without AOD. The following methodologies were applied: basion-dens interval (BDI), basion-axial interval (BAI), Lee X-lines, Powers ratio, CCI, and revised CCI. The average sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as well as the kappa statistic indicating interrater reliability of each method were investigated. Results The average sensitivity for BDI, BAI, Lee X-lines, Power ratio, CCI, and revised CCI was 0.75, 0.33, 0.67, 0.50, 1.00, and 1.00, respectively. The average specificity was 1.00, 1.00, 0.50, 1.00, 0.94, and 1.00, respectively. The average PPV was 1.00, 1.00, 0.25, 1.00, 0.80, and 1.00, respectively. The average NPV was 0.96, 0.88, 0.89, 0.91, 1.00, and 1.00, respectively, and the kappa statistic was 0.57, 0.25, 0.25, 0.20, 1.00, and 1.00, respectively. Conclusion Based on this study, the revised CCI method is simple yet the most sensitive and reliable technique for the diagnosis of AOD.

Original languageEnglish (US)
Pages (from-to)529-534
Number of pages6
JournalGlobal Spine Journal
Issue number6
StatePublished - Sep 1 2016


  • atlanto-occipital dissociation
  • craniovertebral junction
  • dissociation
  • occipitocervical dislocation

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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